Exploring patient perspectives on shared decision making about bariatric surgery in two healthcare systems.

Objective: To assess patient perspectives on the level of shared decision making (SDM) experienced related to bariatric surgery.

Background: Severe obesity is common and has serious health implications. Yet, few eligible patients pursue bariatric surgery.

Identifying barriers to shared decision-making about bariatric surgery in two large health systems.

Objective: Prior research suggests shared decision-making (SDM) could improve patient and health care provider communication about bariatric surgery. The aim of this work was to identify and prioritize barriers to SDM around bariatric surgery to help guide implementation of SDM.

Methods: Two large US health care systems formed multidisciplinary teams to facilitate the implementation of SDM around bariatric surgery.

Primary care physician resource use changes associated with feedback reports.

Objectives: To measure changes in primary care physician (PCP) ordering rates for 4 global resource use measures before and after dissemination of physician feedback reports that provided peer-comparison resource use rates. We also explored whether physician practice characteristics (panel size, clinic size, and years of experience) were associated with resource use changes.

Study Design: Pre-post implementation study measuring physician resource use in an integrated healthcare system (2011-2014).

Primary Care Clinicians' Perspectives on Reducing Low-Value Care in an Integrated Delivery System.

Context: Perceptions about low-value care (eg, medical tests and procedures that may be unnecessary and/or harmful) among clinicians with capitated salaries are unknown.

Objective: Explore clinicians' perceived use of and responsibility for reducing low-value care by focusing on barriers to use, awareness of the Choosing Wisely campaign, and response to reports of peer-comparison resource use and practice patterns.

Methods: Electronic, cross-sectional survey, distributed in 2013, to 304 salaried primary care physicians and physician assistants at Group Health Cooperative.

Decision aids for benign prostatic hyperplasia and prostate cancer.

Objectives: To examine the relationships among implementing decision aids (DAs) for benign prostatic hyperplasia (BPH) and prostate cancer (PRCA), and treatment rates and costs.

Study Design: A pre-post observational evaluation of a quality improvement initiative in a healthcare system in Washington state.

Methods: Men with BPH seen in urology clinics and all men diagnosed with localized PRCA were identified for an intervention period, in which urologists were instructed to order a DA for every patient with those conditions, and a historical control period.

Successful practices in the use of secure e-mail.

Physician use of secure e-mail with patients is anticipated to increase under Stage 2 Meaningful Use requirements, but little is known about how physicians can successfully incorporate it into daily work. We interviewed 27 "super user" physicians at Kaiser Permanente and Group Health who were identified by leaders as being technologically, operationally, and clinically adept and as having high levels of secure e-mail use with patients. They highly valued the use of secure e-mail with patients, despite concerns about a lack of adequate time to respond, and provided tips for using it successfully.

Coordinate regulation of TPL-2 and NF-κB signaling in macrophages by NF-κB1 p105.

The role of IκB kinase (IKK)-induced proteolysis of NF-κB1 p105 in innate immune signaling was investigated using macrophages from Nfkb1(SSAA/SSAA) mice, in which the IKK target serines on p105 are mutated to alanines. We found that the IKK/p105 signaling pathway was essential for TPL-2 kinase activation of extracellular signal-regulated kinase (ERK) mitogen-activate protein (MAP) kinase and modulated the activation of NF-κB. The Nfkb1(SSAA) mutation prevented the agonist-induced release of TPL-2 from its inhibitor p105, which blocked activation of ERK by lipopolysaccharide (LPS), tumor necrosis factor (TNF), CpG, tripalmitoyl-Cys-Ser-Lys (Pam(3)CSK), poly(I · C), flagellin, and R848.